Department: Women’s Health, Chilterns, Southmead Hospital, Westbury on Trym, BS10 5NB
Retrospective cohort study of diagnosis–delivery interval with umbilical cord prolapse: the effect of team training
Article first published online: 11 MAY 2009
© 2009 The Authors Journal compilation © RCOG 2009 BJOG An International Journal of Obstetrics and Gynaecology
BJOG: An International Journal of Obstetrics & Gynaecology
Volume 116, Issue 8, pages 1089–1096, July 2009
How to Cite
Siassakos, D., Hasafa, Z., Sibanda, T., Fox, R., Donald, F., Winter, C. and Draycott, T. (2009), Retrospective cohort study of diagnosis–delivery interval with umbilical cord prolapse: the effect of team training. BJOG: An International Journal of Obstetrics & Gynaecology, 116: 1089–1096. doi: 10.1111/j.1471-0528.2009.02179.x
- Issue published online: 10 JUN 2009
- Article first published online: 11 MAY 2009
- Accepted 8 January 2009. Published Online 11 May 2009.
- Medical simulation;
- obstetric emergencies;
- umbilical cord prolapse
Objective To determine whether the introduction of multi-professional simulation training was associated with improvements in the management of cord prolapse, in particular, the diagnosis–delivery interval (DDI).
Design Retrospective cohort study.
Setting Large tertiary maternity unit within a University Hospital in the United Kingdom.
Sample All cases of cord prolapse with informative case record: 34 pre-training, 28 post-training.
Methods Review of hospital notes and software system entries; comparison of quality of management for umbilical cord prolapse pre-training (1993–99) and post-training (2001–07).
Main outcome measures Diagnosis–delivery interval; proportion of caesarean section (CS) in whom actions were taken to reduce cord compression; type of anaesthesia for CS births; rate of low (<7) 5-minute Apgar scores; rate of admission to neonatal intensive care unit (NICU) (if birthweight >2500 g).
Results After training, there was a statistically significant reduction in median DDI from 25 to 14.5 minutes (P < 0.001). Post-training, there was also a statistically significant increase in the proportion of CS where recommended actions had been performed (from 34.78 to 82.35%, P = 0.003). There was a nonsignificant increase in the use of spinal anaesthesia for CS, from 8.70 to 17.65%, and a nonsignificant reduction in the rate of low Apgar scores from 6.45 to 0% and in the rate of admission to NICU from 38.46 to 22.22%.
Conclusions The introduction of annual training, in accordance with national recommendations, was associated with improved management of cord prolapse. Future studies could assess whether this improved management translates into better outcomes for babies and their mothers.